Evaluation of a 3-month intervention with high protein, omega-3 LC-PUFA enriched oral nutritional supplement on body weight, inflammation, muscle strength and patient reported outcomes in patients with cancer

Purpose To compensate for reduced nutritional intake and altered metabolic needs in cancer, ESMO and ESPEN recommend higher than normal energy and protein intake, with omega-3 long chain polyunsaturated fatty acid (LC-PUFA) supplementation to target inflammation. Methods In this multi-center, single arm study adult outpatients with or at risk of malnutrition and requiring ONS were prescribed 2 x 125 ml high protein (HP), omega-3 LC-PUFA enriched ONS (Forticare Advanced, 18 g protein, 306 kcal, 1.1 g EPA, 0.7 g DHA, 10 µg vitamin D) daily for 3 months. Body weight (BW), adherence to ONS (primary outcomes), C-reactive protein (CRP), hand grip strength (HGS), 30-second chair stand test (CST) and patient reported outcomes were assessed at baseline (Day 0), 1 and 3 months. Results 761 patients (47.5% male, mean age 65 (SD 12) years) were included. At baseline, 77.9% of patients had > 5% weight loss (WL) and had higher CRP and lower albumin levels than patients with < 5% WL (p < 0.001). Average adherence to the ONS was 1.7 (85%) bottles/d, despite 34% of patients reporting altered taste/smell. Mean gain in BW was 1 kg (p < 0.0001) with 76% of patients gaining or stabilizing BW over 3 months. CRP levels decreased (mean − 7.5 mg/L (p < 0.0001), physical performance improved (increase in HGS (+ 1.2 kg, p < 0.0001) and CST (+ 1.4 stands, p < 0.0001)) and patients reported improved physical aspects of quality of life (p < 0.001) at 3 months. Conclusion In this study, patients with cancer prescribed HP, omega-3 LC-PUFA enriched ONS for 3-months gained weight, experienced reduced inflammation, and improved physical performance and patient reported outcomes.